IMT decisions back in the hands of the hospitals

The rules of the game have changed. Since the inception of the National Programme for IT (NPfIT) in 2005, the responsibility for specifying, procuring, configuring and deploying major hospital systems has been centralised and the role of local management had become one largely characterised as facilitation. Now though, following a Department of Health review and the announcement in a ministerial statement that the NPfIT is “no longer required”, executive decisions regarding the full breadth of Information Management & Technology (IMT) need to be back on the agenda of board meetings up and down the NHS in England and Wales.
The announcement is that the centralised approach of NPfIT is no longer relevant and IMT decisions should be local, with more modular systems being selected from a plural system of supply. What is more, the tone set in the white paper is continued- that healthcare provision needs to improve, yet the costs need reduce. So providers quickly need to pick up the mantle and take control of how IMT will enable their organisation to deliver this objective.
This new onus on Trust boards brings the need for them to be more tech savvy than they have previously needed to be. Not only are the decisions and responsibility for system delivery back with them, but a plural market requires significantly more expertise, not only in system selection, but also in architecting how more modular systems will be orchestrated to deliver their digital platform. As the Operating Framework for the NHS in England puts it, the approach is about “connecting all” rather than “replacing all”. Integration is the name of the game and the challenge of making a handful of interoperable systems drive an organisation is exponentially more demanding than merely multiplying up the effort of making a single system work.

British Computer Society Recommend CfH Changes

A report by the British Computer Society is being widely reported at the moment. I wish to do little else than add my voice to those who say "here here". I believe it is a very rounded review and I would urge anyone in the NHS, DH or Healthcare IT to read the full version- and not just what they read in the press.

The only thing I would add is that a move away from monolithic systems to interoperable standards will require an evolution in the maturity of healthcare IT (See There be Dragons in Phase 4). The commercial environment required to enable this out-of-cashflow investment would probably be too large to run alongside NPfIT. As expensive as it is, the systems being implemented through LSPs are only an incremental improvement at a functional level rather than a fundamental rearchitecting. We need to focus on some core areas and keep them simple if this is to work.

Tags: technology, healthcare IT, health care IT, IT, information technology, NPfIT, CfH, NHS, BCS, British Computer Society, IT architecture, interoperable, monolithic

NHS Cautiously Proceeds with Patient Records

It's been announced that Lord Warner has decided that the NHS should press on with the National Care Record System- albeit in a watered down 'summary' format and with the ability to opt-out and keep your data local.

I welcome the news. Well, I welcome the progress bit within the news. We're out of the gate. Personally, I'm happy for the brakes to be taken off the technology but the media suggests that the public thinks differently. This announcement leaves the path open to eventually extend the summary records into being more detailed and provides the opportunity for people to see the benefits. I want all of my medical records on line NOW and I want to contribute to it. It's my information and I feel that future clinicians I have the misfortune to need the services of will be able to serve me better if they have more information. The further away I am from my friends and relatives at home when I need that help, the more I want the information available to clinicians with my life in their hands.

Security? It's doable. What's more, do you know what they're doing now? When were you last asked for your consent? Believe me, technology will be better- it can be explicit. The problem with health care is that moral dilemmas are always a short step away which can bring progress to a stiffling halt. Am I the only person who wants to live longer and healthier?

And in case anyone asks... GPs do not represent me. The media keeps giving the GPs' opinion as if it is surrogate for the public. Not so. Ask me.

Tags: technology, health care, healthcare, IT, healthcare IT, health care IT, information technology, EMR, Electronic Medical Record, EHR, Electronic Health Record, NCRS, National care Record System, NHS, National Health Service, CfH, Connecting for Health, NPfIT, National Programme for IT

Adobe Acrobat 1: Information Governance 0

I was looking for a piece of information earlier today and stumbled across a PDF document online courtesy of Google. It turns out that the document is a 'leaked' "Commercially in Confidence" report of the National Audit Office on the NHS's National Programme for IT. The copy I was looking at was on the BBC website. There are some things in the report which would come as no surprise for most professionals, but obviously the press picked up on them and had a field day. What is really interesting though is that either the source or the BBC chose to black out some of the text which they deemed particularly sensitive. Therefore you can't read it in the PDF...

...or can you?

Of course you can. You simply select the blacked out text and cut and paste it into another application. Hey presto, you can read it as plain as day.

It makes for interesting reading, but my point is that office applications are so feature rich these days that users often lose out in the security stakes to them. "Track changes" in Microsoft Word is also a great example. The contracts I, or my colleagues, have been sent where you can recollect the internal discussions and tactics of the opposite parties, never cease to surprise me.

Tags: Acrobat, Adobe, CfH, Connecting for health, NPfIT, National Programme for IT, commercially in confidence, information governance, Microsoft, Word, healthcare, Healthcare IT, NHS, health care, NAO, National Audit Office, security

Abuse of Chatham House Rules

I was pleased to meet with Richard Granger, the Director General of NHS Connecting For Health, (aka NHS IT Chief) earlier this week. I have to say he was very impressive and it was a good opportunity to hear about the GREAT progress being made in many areas of the National Programme for IT. Clearly, all things the press is not interested in printing.

However, I can't say any more because the event was Chatham House rules. That is, people can take away what was said in the meeting, but it is not to be referenced in a way which makes it attributable to any individual present. This encourages openness and enables us all to learn from mistakes as well as successes.

Richard Granger suffers much at the hands the media. You could argue that's just part of the job- and that is fair enough. My point is that comments which he made last week in a Chatham House rules governed event are now splashed across the pages of the New Statesman and have been picked up by all the usual healthcare IT publishers. We have to lose this rapcious appetite for sensational headlines if we can have reasonable discussions we can all learn from.

Tags: technology, IT, CfH, Connecting for health, NPfIT, National Programme for IT, Chatham House rules, Chatham, health, health care, healthcare, Healthcare IT, NHS, Richard Granger, Granger